If the cause is just, shouldn’t the means to pass health care reform be free of legal trickery? Most of the 37 representatives that voted no on the bill last time around are up for reelection and are therefore very concerned about how their constituents will react to this most important vote that will impact all Americans.

The fate of health care reform is at stake and on March 17 House Speaker Nancy Pelosi and President Obama helped to persuade many including Rep. Dennis Kucinich (D-OH) despite the fact that the bill does not contain the public option he fought for. He said, “This is not the bill I wanted to support.” But after a trip to his district and much discussion, Obama got Kucinich’s vote.

Some representatives refuse to vote in favor of the Senate bill because they don’t like some of what is in it and they don’t want it held against them in November. But it must pass before any of the changes House members want can be made. How then can this be accomplished? A little known rule called “Deem and Pass” may be the solution. The House would not vote on the Senate bill directly, but would vote on a separate bill that does contain the changes and then the Senate bill would be “deemed to have passed.”

In a very contentious interview on March 17 with Bret Baier of Fox News, Obama was challenged to explain why, after weeks of saying “the United States Congress owes the American people a final up of down vote on health care” he could support use of the deem and pass rule. Obama responded, “But here’s the thing, Bret, I mean, the reason that I think this conversation ends up being a little frustrating is because the focus entirely is on Washington process. And yes, I have said that is an ugly process. It was ugly when Republicans were in charge, it was ugly were in Democrats were in charge.”

The process is ugly. But when the bill represents one-sixth of the U.S. economy, it seems a traditional vote is necessary even if it takes longer to pass.

What are the changes respresentatives are so concerned about? One is the impact this bill may have on the deficit and on March 18, the Congressional Budget Office (CBO) released its estimated cost of the updated package. CBO said it would cost $940 billion over the next decade. This would not add to the deficit which remains a key concern for many representatives. House Democratic Whip James Clyburn (D-SC) said, “We are absolutely giddy over the great news that we’ve gotten from the CBO.”

Obama promised to expand coverage while slashing the deficit. This strategy is intended to win over fiscal conservatives. He delivered on this promise. But there are other concerns.

Rep. John Boccier (D-OH) voiced another concern on CNN’s “American Morning” March 18. He said, “I’m encouraged by that. But there needs to be changes. The Senate version — there’s no way Ohio should have to pay for Nebraska. I want those deals out.” Boccier was referring to “deal” in the Senate’s bill which exempted Nebraska from the costs of expanded Medicaid coverage in order to win the vote of Senator Ben Nelson (D-NE).

Rep. Luis Gutierrez (D-IL) has argued that he could not support the Senate bill because it would, “ban illegal immigrants from using their own money to buy insurance on the exchange.” Some reports indicate Gutierrez may be willing to change his vote if there are trade-offs which could help immigrants with housing issues.

 The vote will not occur before Sunday because House Democrats are upholding their promise to post the bill 72 hours before a vote. It will take time to read this bill and even longer to comprehend it all.

These convoluted deals and trade-offs leave a bad taste in the mouths of most American voters. Critical thinkers must ask, why do they have to be there?